Pulse count and blood pressure



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I PULSE COUNT AND BLOOD PRESSURE APPARATUS B. w. WILLIAMS ETAL A FiledMarch- 2o, 1940 13 sheets-sheet 11 Bly M PULsE ooUNTAND BLooD PRESSUREAPPARATUS Filedm'arcn 2o, 1940 13 Sheets-Sheet 12 i July 15, 1941- B. w.WILLIAMS Erl-ALv y 2,249,370. A PULSEQOUNT AND BLQoD PRESSURE APARATUSt* 1 Filed March' 2o.' 1940 1s snee'ts-sneet 1s 1 Patented July 15, 1941UNITED STATES PATE NT OFFICE PULSE COUNT AND PRESSURE Bradlee W.Williams and Homer S. Williams, Chicago, Ill., assignors to TechEquipment Company, Chicago, Ill., a corporation of Illinois ApplicationMarch 20, 1940, Serial No. 325,017 y 56 Claims." (Cl. 12S-2115)- ring tothe number of systoles per minute. A

systole or systolic heart beat is that period in the functioning of theheart when it is contracting and forcing blood through the arteries inthe course of which the arteries expand, the periods of greatestexpansion being those which are discerned and counted and being thepeaks of the systoles, the periods of rest between the systoles t beingknown as diastoles and in the course of which the arteries contract'fromthe expanded state acquired thereby during the systoles whereby the iowof blood through the-arteriesis contnued during the diastoles. the peaksof the systoles, are usually discerned and counted at the volar aspectof the wrist where the expansions of the radial artery in the forearm inresponse to systoles are discerned.

The systolic blood pressure of the human body, that is, the pressureinthe arteries during systoles, is customarily expressed in terms ofmillimeters of mercury. 'I'his pressure is usually ascertained byapplying sufficient extraneous pressure to the upper arm to collapse thebrachial artery and thereby ,interrupt the flow of blood therethrough.Once the flow oi' blood' through this artery hasbeen interrupted, theextraneous pressure is gradually reduced and when the rduction is suchthat .the extraneous pressure is equal to the systolic pressure in thebrachial artery then; by reason of the tendency of the brachial arteryto expand and the systolic pressure in such artery, the effectof theextraneous pressure. is overcome and blood again courses through thebrachial artery to the radial artery which leads therefrom. Suchresumption of the now of blood through the-radial artery may beperceived either at the volar aspecto! the wrist,

by the sense of touch, or by the sense of hearing through the medium ofa stethoscope applied to the volar aspect of the arm at the cubitalfossa,y The gradual reduction of the extraneous presterms of millimetersof mercury, yis employed to t measure the extraneous pressure applied tocolklapse the brachial artery and the reading thereof, when theaforesaid gradual reduction of such pressure is interrupted, is thesystolic blood pressure in terms of millimeters ofimercury.

From the foregoing -it will be understood that the radial artery in theforearm is customarily entailed in the ascertainment of the pulse andsystolic blood pressure of thefhuman body, and

' among the objects of the present invention is to ascertain the pulseand systolic blood pressure in I the human body from the radial arteryin a novel tained by'rst applying sufiicient extraneousl Systoles, orrather l and accurate manner.

In accordance with the gpresentinvention, the 1 pulse, that is, thefrequency of the systoles, is detected and ascertained at the volaraspect of the Wrist and the lsystolic blood pressure is ascertion of theextraneous pressure being interrupted when the resumption of blood flowthrough the radial arterypast the volar aspect of the wristv is theredetected, the degree of extraneous pressure remaining when Atheaforesaid reduction of such pressure is so interrupted being equal tothe vsystolic blood pressure, and an'important object` of our inventionis to effect the foregoing in a novel manner by 4the utilization ofnovel means. Still another object, is to count Aonly. `those arterialexpansions. induced by systoles so as not to'count the dicrotic phase ofa pulse'beat as a systolic effect, su'chdicrotic phase of a pulse beatbeing the result of a decrease in the blood press'ure arising while thesemilunar valves of they aorta are closing as an tincident tothelnitiation of a diastole, there being an increase in the bloodpressure, with an accompanying expansiony of the arteries, for a briefperiod followingsuch closing ofthe valves. This increase lin bloodpressure is in the nature of a systolic effect.

sure is interrupted as soon as the resumption of but is, in reality,merely an attribute of che closingv of the semilunar'v valves. In anabnormal condition, where the semilunar valves close quitey i slowly,the dicrotic phase ofthe pulse beat may be of such relativelysubstantial proportions that thev effect thereof inI the arteries willapproach the Aeffect of a systole and adias'tole therein. Hence, anobject ancillary to that last set forth is to insure that only truesystolic eiects in the i instances other than those responsive tosystolic and diastolic effects in the arteries.

Other objects of this-invention -are to apply fluid pressure in a closedsystem against the volar aspect of the wrist andto operate meansincluded in such a closed system in response to the effect of systolesand diastoles impressed 'y on the system at the volar aspect of thewrist;

during an established time interval; and to prevent an initiation ofsuch a' predetermined operation, once such an operation. has beeninitiated, during a period of time shorter than the period of time whichwill intervene between true systolic effects in the arteries wherebyeffects in the nature of systolic effects, such as may arise in thedicrotic phase of a pulse beat, will not be counted as systolic effects,the length of such period of time during which initiation of theaforesaid predetermined operation is prevented being dependent upon themaximum pulse to be counted by the machine. Thus, if the machine is tobe operative to count pulses up to one hundred and five beats perminute, then the initiation of the aforesaid predetermined operationwill be,

prevented for a period slightly less than about 0.571 second, the timeintervening between true systoliceiects in the arteries where'the -pulseis l a systolic eiect in the arteries' and to continue such operation ineiect until a diastolic effect occurs in the arteries andl to preventre-initiation of such operation in response to a systolic effect untilafter the elapse of a predetermined period of time; and to utilize.means for effecting the foregoing which will be capable of use in'mstances other than the counting of systolic effects in thevarteries. y

Still more specific objects ancillary to the foregoing are to effectenergization of anelectricallyoperated device, such as a relay, inresponse to systolic eiects in the arteries; to maintain such a devicein operation once it is so set in operation, as by establishing a stickor holding circuit therefor, and to interrupt such operation in responseto a diastolic eiect in the arteries subsequent to `the systolic effectinitiating such operation. as by effecting energization of anelectrically-operated device, such as a relay, and throughA which astick lorholding circuit, as aforesaid, is established, in response to adiastolic effect, as aforesaid; and to prevent energization of such anelectrically-operated device in response to a systolic effect in thearteries until after'the elapse of a predetermined period of time;whereby an electrically-operated device, such as a relay, may berendered operative in response to a systolic efrect in the arteries andmay continue in operation until another electrically-operated device,such as a relay. is energized in response to adiastoliceffect in thearteries and also whereby reto retain the volar aspect of the Wrist inengagement with a yieldable member and to force a fluid into suchyieldable member until a predetermined pressure is built up therein andto thereafter releasably maintain such predetermined pressure -in theyieldable member; and

to-force a liquid into the system including the yieldable lmember sothat, .when the system is closedafter a predetermined pressure isestablished therein, a hydraulic system is aiorded i through which theeiectof systoles and diastoles impressed on the system at the volaraspect'of the wrist may be transmitted, whereby the eiect of systolesand diastoles impressed on the system at the wrist may be utilized at aplace or places in the system remote from the wrist.

'I'he magnitude of systoles. and resultantly of diastoles, variessubstantially from person to person which means that in one person thesystoles will afford appreciable force while in another the force of thesystoles `will be little more than perceptible. Thus if a yieldablevmember is applied to the volar aspect of the wrist, to be responsive tothe effect of systoles and diastoles in the radial artery leading pastsuch aspect it'will, in some instances, have appreciable force appliedthereon and in others have but slight force applied and this would, ofcourse, be true of any means that might be utilized to sense systolicand diastolic effects in the arteries. Thus in those instances where. ashere, the sensed effects of the systolic. and diastolic phases of ytheheart beat are to be utilized to initiate a predetermined operation andto interrupt such operation, and where, this is to |be effected throughthe intermediary of means responsive to variations inv pressure, vwherethe magnitude of such variations in pressure may vary from time to timeas do the systolic and 'diastolic effects in the arteries of differentpersons, it is advantageous to take cognizance of slight as well assubstantial variations, and so to, do is still another object of ourinvention, and la. related object is to insure accurate functioning ofmeans responsive to systolic and diastolic effects irrespective of theforce or magnitude of the systolic effects and, resultingly, of thediastolic effects, and a further object is to utilize the effect ofsystolesand diastoles in the radial artery of a person, irrespective ofthe magnitude thereof, to count the systolic heart beats of such person.

Objects `related to the immediately foregoing objects are to affordrelative movement between selected operative parts in an apparatusresponsive to periodic variations in pressure or the like andtherebyenable utilization of the apparatus in those instances where themagnitude of such periodic variations may vary from time to time:

to eiect movement of one of such relatively movable members from theother as an Iincident to the initiation of movement of such othervmember; to limit the movement of such one member with suchl othermember and thereby enable the relative movement of which such membersare capable to take place;y and to enable a control operation or controloprations to be eifected in response to the 'movement of `said onemember that last set forth are to closel and open one or more electricalcircuits in response to movements Vof said one member with the other;and to effect lated to the foregoing is to enable the'utiiization of anarrangement such as the foregoing ,in instances other than theascertainment'of the pulse lnthe human body, and a still further ob`energizat'ion and deenergization of one or moreV 5 ject related totheforegoing is to enable register-I electrically-operated devices, such asrelays, in.

responsevtothe movement of said one member with the other.

Yet further objects pertaining to the immediately foregoing objects areto effect reciprocation of a member and to associate with suchreciprocatory member another memberlwhich will move with thereciprocatory member only briefly during each phase of the reciprocationthereof; to initiate an operation in response to movement of such othermember with the reciprocatoryfmember when said reciprocatory membermoves in one direction and to interrupt such operation upon movement ofsuch other member with the reciprocatory member when the reciprocatorymeml Y ber moves in the opposite direction; to effect eciprocation ofsuch reciprocatory member through the intermediary of means included ina closed system responsive to variations in pressure such as may beinduced by systolic and diastolic effects in the arteries; and to`attach a reciprocatory member to a bellows compressible thereof untilmovement of such Aother member is interrupted, wherefore movement of thereciprocatory member in the direction -in which it was moving when themovement of such other member was interrupted may continue withoutoperative effect on such other member;

Further objects are tov provide a system including a. yieldable memberthat may be applied to the volar aspect of a wrist; to force aeliquidunder pressurelntosaid system until a predeterminedpressurc is built up'therein and to then close off -said system so as to maintain such pre-v,the volar aspectA of the aforesaid Ywrist, impressed. on such yieldablemember engaged with such volar-aspect will induce correspondingpulsations in saidclosed system; to include in said closed system amember movable in response to pulsations impressed .thereon; toassociate with such v member a member movable therewith but to limit themovement of such other member with the first member in such a way thatpulsations of slight or comparatively great magnitude in said anotherpredetermined timeV once such periods l of operation are initiated; andto ascertain the number of such periods of operation in such otherpredetermined time and thereby determine the pulse in the human bodyincluding the wrist against the volar aspect of which the aforesaid`yieldable member is engaged; and an object re- 50 aforesaid. vFurtherobjects related to the foregoing are ing or recording of the aforesaidnumber' of periods of operation in said, other predetermined period oftime to thereby facilitate ascertainment of thevpulse of a human body orthelike.

to ascertain the degree of pressure entailed in producing apressure-effected function discernible at a particular place by rstapplying sufficient i extraneous pressure to overcome the pressureentailed in effecting the function and thereby interrupt the function,at least at the place where it is discerniblefand to thereafter reducethe extraneous pressure until the entailed pressure overcomes theextraneous pressure and causes the function to be resumed at least atthe place wher it is discernible and to interrupt reduction of theextraneous pressure, whenthe-funtion has been so resumed, to bring aboutpredeterminedeifects and to thereupon ascertain the degree of extraneouspressure when the reduction thereof is interrupted under the aforesaidconditions whereby, since the entailed and extraneous pressures will beequal v'when the entailed pressure overcomes the extraneous pressure,the degree of en- '30 tailed pressure may be ascertained.'

An object related to the foregoing is to so apply extraneous pressurethat the flow of Yblood through the radial artery of an arm of a humanbody may be interrupted and to thereafter reduce the extraneous pressureso applied until the tendency of the artery so collapsed to, expand, andthe systolic blood pressure therein, overcomes the extraneous pressure;and -to thereupon suspend reduction of the extraneous pressure if pre-4o determined effects in the radial artery, by reason of the. resumptionof the flow of'vr blood therethrough, are disposed at the'volarnaspectof the wrist past which such artery leads, whereby the It is anotherimportant object of this invention l systolic blood pressure in thehumanbody mayk traneous pressure when the reduction thereof is suspended,since the extraneous .pressure and systolic blood pressure will be equalwhen the eff extraneous pressure is overcome as fect of the' .to applysuch pressure lto the volar aspect ofA an arm of the Vhuman body `thatthe flow of blood through the radial artery leading past su'ch volar .55aspect will be interrupted; to thereafter graduvolar aspect-of the wristof the arm through be ascertained by determining the degree of ex-Adetermined pressure tlierein whereby systolic and diastolic effects inthe radial artery, leading past 60, flow of blood through the radialartery past the which such artery leads is resumed; to effectr suchreduction of the extraneouspressure ,applied to the volar aspect ofthearmas aforesaid in'a wrist; to interrupt further reduction of theextraneous pressure applied to the volar aspect-of the arm as aforesaidwhen predetermined systolic and intervening diastolic 'effects arediscernedV at the volar aspect of the wrist subsequent toa sus'- pensionof the reduction of the extraneous pres- 65 step by step manner; tosuspend the gradual rel sure as aforesaid; to resimie gradual reductionof the extraneous pressure when predetermined ,systolic and attendantdiastolic effects are not discerned at the volar aspect of the wristsubsequent to the suspension of a reduction of such pressure asaforesaid, but to interrupt such further reduction of the extraneouspressure when the aforesaid predetermined systolic and related diastoliceffects are discerned at the volar aspect of the wrist.; to enable thedegree of extraneous pressure to be ascertained when thegradualreduction of such pressure is interrupted as aforesaid; and to utilizemans for effecting the 4foregoing which will be capable of use ininstances other than the ascertaining of the systolic blood pressure inthe human body as instances entaili ing pressure-induced pulsations.

- off communication between such systems under tem includingpressure-measuring means .in respense tothe pressure in the aforesaidclosed system; to interrupt communication between such other systemlandthe closed system inresponse to predetermined conditions and subse-`quent to the time when operation of the means controll'lngrthe releaseof fluid from the system of predetermined capacity is prevented; Aand toelectrically operatethe means which closes off communication betweensuch other system and the aforesaid closed system and to eEect operationof such electrically-operated means to close predetermined conditions`and subsequent to the Yet further objects of our invention are toappiysuificient extraneous pressure of the volar as pect of an arm ofthe human body to collapse the radial artery leading past the volaraspect of such arm and thereby interrupt the flow of bloodtherethroughas by establishing ,such pressure -Y under theiniluence ofthe height of a mercury column in a manometer or in response tb otherequivalent pressure measuring means; to gradually reduce the pressure soinduced in a step by step manner and to interrupt such reduction whenpredetermined e'ects are discerned at the `volar aspect of the wristpast which the aforesaid radial artery leads and which effects are setupby the coursing of blood through the radial artery when the tendencyof such artery to expand, and the' systolic blood pressure therein,

overcomesthe effect of the extraneous pressure. at which time thesystolic blood pressure and the extraneous pressure will be equal; to`establish a column of mercury. as aforesaid or the like through theintermediary of fluid pressure established ina closed system; toestablish and maintain such `a closed .system when predetermined theaforesaid stepby step reduction by intermittently releasingpredetermined quantities of fluidA from the aforesaid closed system; tosuspend the release of uid from the aforesaid closed system in responseto predetermined conditions and to fully interrupt such release of fluidfrom the closedsystem under further predetermined conditions related tothe last-mentioned predetermined conditions; to enable the height I ofthe mercuryl column or the condition of other Objects ancillary -to theimmediately foregoing objects areto release fluid from the aforesaidclosed system into a system of predetermined capacity and to thereafterclose of! communication between such systems; to release fluid from thesystem of -predetermined capacity when this system'is out ofcommunication with the aforesaid closed system; to prevent the releaseof fluid from the; system of predetermined capacity*y upon predeterminedconditions; to electrically- -Aoperate the means for effectingrelease offluid from the aforesaid system of predetermined capacity and to effectoperationy of such electrically-operated means under predeterminedconditions; to4 establish pressure in another sys-k time whenoperation'of the electrically-oper'- ated means controlling the releaseof fluid from the aforesaidsystem of predetermined capacity is effected;a lfurther and related object to the immediately foregoing being toafford independent circuits to the aforesaid two electrically-operateddevices and to utilize switch means constructed and arranged to open oneof said cir- )cuits in response to predetermined conditions and alsoconstructed and arranged to break the other of said circuits in responseto predetermined conditions and subsequent to the time the first of saidcircuits is broken.'

- Still further .objects of this invention are to cause contact lingersto assume predetermined positions with respect to contact strips when anapparatus of the kind to which this invention pertains is initially setin operation; to retract such contact fingers away from the aforesaidfluid pressure is built up therein; to bring about .positions assumedthereby in a step by step manner; and to establish such relation betweenthe' respective contact n'gers andlcontactstrips engageable therebythatvone of such contact fingers will move from'engagernent with one ofsuch contact strips in the course of the step by step retraction thereofprior to the time the other of such contact fingers moves fromlengagement with` the contact strip engaged thereby in the lcourse of thestep by step retraction of such contact fingers; and an object relatedto the foregoing is to effect the step by step retraction of the contactfingers in response to systolic. and l diastolic e'ects in a radial.artery leading past the volar aspect of the wrist of an arm of a humanbody, and a yet further related object is tov insure that fulldisengagement of the contact fingers from the contact strips cooperatingthere-v. with will not be effected until a predetermined number ofsystolic and diastolic effects have been discerned at theaforesaid-'volar aspect of a wrist.

Still other important objects of this invention are to first ascertain`the pulse in ahuman body and to thereafter ascertain the systolic bloodpressure therein; to suspend the operation of ascertaining the systolicblood pressure until the operation of ascertaining the pulse has beencompleted; to initiate the operation of ascertaining they systolic,blood pressure subsequent to' the completion of the operation ofascertaining the pulse and to prevent the initiation of an operation ofascertaining the. pulse until the,comple tion of an operation forascertaining the systolic lblood pressure; to suspend an operation forascertaining the pulseuntil predetermined conditions are to determinethe systolic blood pressure under control of systolic and diastoliceffects in the radial artery discerned at the volar aspect of the Ywrist past which such artery leads; to insure that only systolic anddiastolic effects discerned at the volar aspect of the wrist will beeifective to determine the systolic blood pressure; to utilize uidpressure in a closed` system to discern systolic and diastolic effectsat the volar aspect of the wrist -and to so arrange the meansvunder inthe bight thereof and to set such liquid in motion in response tosystolic and resultantly diastolic effects sensed in the course ofoperation of the apparatus.

Still further objects are to electrically manifest the force andmagnitude of systolic and diastolic effects sensedin the course ofoperation I of the apparatus; to enable relatively weak and control ofthe fluid pressure in such system that only predetermined repetitiouspulsations will bring about operation of the means for registering orrecording the systolic vblood pressure,

whereby other effects on such system will be prevented from operatingsuch registering or recording means so as to thereby prevent theregistering or recording of an incorrect systolic blood pressure. i

Yet further objects are to enable uid Apreslimited movements induced inthe course-of operation of the `:apparatus to beutilized for effectingselected operations therein; to enable relatively weak andv limitedmovements induced in the course of operation of the apparatus to be soamplified that power-entailing operations may be effected therefrom; toenable such operations,

to be effected by the utilization of electronic tubes; to utilizepressure responsive meansfor sure to be established and maintained in aclosed system in response to the iiuid pressure therein; to enable apredetermined uid pressure to be builtV up in a closed system and tothereafter effect reduction in the uid pressure in such system; toestablish fluid pressure in a system int cluding pressure registering orrecording means from a closed system in which a uid pressure isestablished but which may be reducedina step by step manner; and toenable the fiuid pressure to be relieved from the aforesaid cldsed'systems when so desired but at the same time to prevent the relief offluid pressure from the sys-.

tem including the pressure registering or-recording means. Y

Still further objects of this invention areu to insure operation ofvarious operative' -mechatI anisms included in the apparatus 'inpredetermined timed relation one with the other; to utilize a commontiming means to insure that the foregoing may be brought about; toinclude switching means in the common timing means through whichelectrical circuits may be established at predetermined times andfor;prede termined periods of time; and to utilize said timing means tosuspend the initiation of the operations to be controlled thereby untilpredetermined conditions prevail so as to thereby insure proper timedrelation among the various operative mechanisms controlled by saidtiming means. i

Further objects are to enable a record to be made of the results ofoperations of the apparatus; to utilize suitable printing means toproduce such record on a ticket or the like; to enable such a ticket orthe like to be cut from a web or stripof material which may beconveniently a stored in the machine; to sever such ticket-from the webor strip of material after the results of operation of themachine havebeen recorded accompanying drawings which, by way of illusthereon; andto thereafter so advance the strip that another ticket may be cuttherefrom in an operation of the machine subsequent to that in which aparticular ticket is so cut from the strip.-

Yet further objects are to manifest'the force and magnitude of systolic,and yresultingly diastolic, effects sensed. in the course of operationof the apparatuspto sense systolic and diastolic eiiects in the radialartery of a user of the apparatus at the volar aspect of the wrist of auser yand to effect movement of a liquid in response of such sensedeffects; to operate a pumpin rei sponse to sensed systolic and diastoliceffects to' thereby eect fluid movement in response to such effects; andto utilize a U-tubehaving liquid effecting variations in electricalcircuits and to bring about predetermined operations under a control ofsuch pressure responsive means; to produce a graphic illustration offunctions sensed inthe course of operation of the apparatus; and toproduce a graph illustrative of the force and magnitude and otheraspects of systolic and diastolic effects sensed in the course ofoperation of the apparatus.-

Among further objects offthis inventionare to enable an operation oftheapparatus to ensue for but a predetermined period of time; to

maintaina predetermined operative condition in the machine for apredetermined period of time and to thereafter interruptvsuchpredetermined condition and prevent reestabiishment thereof until a newcycle of operation is tov proceed; to`

tration, show preferred embodimentsand the principles 'thereof and whatwe now consider to be the best mode in which we have Acontemplatedapplying those principles. Other embodiments of the inventionembodyingthe same or equivalent principles may be used and structuralchanges'mayl be made as desired by those skilled in the art withoutdeparting from the present i invention and claims.

In the drawings, Fig. 1 isa front elevation of a machine embodying ourinvention;

the purview of the appendedy Fig. 2 is a side elevational view. lookingin at.. y

f the right-hand side of Fig. 1;

Fig. 3 is a plan View of the machine shown in Fig. 1; a

Fig. 4 is a rear elevational view of the upper,

portion of the machine shown in Fig. 1` with the back wall of themachine removed;

- substantially on the line 5 5 on Fig. 4;

Fig. 6 is a, detail elevational view, in which certain parts arebrokenaway,- of .a pump and allied apparatus appearing in the lowerrightf hand corner of Fig. 4; Y

Fig. 5 is a plan view partly in section taken and respectivclynn thelines 9-9 and |0--Iil on y Fis. 4:

Fig. 11 is an elevation of a switch employed in the apparatus;

Figs. 12 and 13 are sectional-detail views taken substantially andrespectively on the lines I2--i2- and I3--l3-on Fig.11; Fig.v 14 is asectional detail-view taken substantiallyfon the line-i4l4 on Fig..3;

Figs. 15 and 16 are transverse sectional detail views takensubstantially and respectively onthe lines li-ii and l-IB on Fig. 14;

Fig. 17 is a sectional detail view taken substantialiy on the line i1-i1on Fig. 4; Fig. 18 is an-elevation of the device of Fig. 17 looking fromleft to right thereof and in the direction of lines I8-l8;

Fig. 19 is a detail view, drawn to an enlarged scale, of a portion ofthe apparatus shown in lFig. 18 but looking in the opposite directionfrom Fig. 20 is a sectional detail view taken substantially on the line20-20 on Fig. 17;

Fig. 21 is a view taken substantially on the line 2|-2l on Fig. 18;

Fig. 22 is a sectional detail view taken substahtia'lly on the line22-22 on Fig. 14;

Fig.f23is an elevational view taken substantially 'on the line 23-23 onFig. 5;

Fig. 24 is an elevational view of the apparatus shown in Fig. 23 butlooking in the opposite direction from Fig. 23;

Fig. 25 is a view taken substantially on the line 23-23 on Figa; Fig. 26is a schematic view showing the op erative parts in the apparatus andthe connections therebetween;

Fig. 27 is a fragmentary front elevational view similar to Fig. 1,showing another form of the apparatus:

Fig. 28 is a fragmentary rear view, similar to Fig.` 4, oi' the form ofthe apparatus shownin Fis.27;

certain operative parts of the machine illustrated in the accompanyingdrawings are mounted, the front wall of this housing 33 preferably beingafforded by a translucent panel 34 on which certain indicia arearranged, as will be explained more fully hereinafter.

An arm rest 351s' mounted on the shelf 32,v

preferably near the right-hand end thereof as viewed in Fig. 3, and thisarm rest includes. at the right-hand end thereof, in the presentinstance,

- a formed portion 36 in which the palm of the left hand of auser of themachine may be rested, and

suitable recesses as 31 are `associated with this portion 3 3 to receivethe fingers of such left hand.

The arm rest 35 is preferably` so formed and of' such a length that,when the palm of the left handof a user is disposed in the formedportion 34, the volar aspect' of the, left arm of the user may rest in atrough-like portion formed, in the upper surface of the armv rest 35with the dorsal aspect of the arm in positio'nto be engagedby the wristand arm straps 33 and 33,- as described y 1, through which a returnedcoin may'lbe removed from vthe coin-return duct, the usual knob 46 beingprovided and which, when grasped, is oper- 35- able to cause return of acoin through the return duct 44.

The apparatus in lthe illustrated form of the a machine `first operates,in the first described form ofthe apparatus, to register the pulse andthereafter to' register the systolic blood' pressure and, while themachine is shown as being coin-controlled, it will be understood thatother means could be substituted for the coin control for'inltiatingmachine operation'.

same direction as Fig. 19, but showing a modified form of the apparatus;

- Fig. 34 is a side view of the apparatus shown in Fig. 33: and

Fig. 35 is a wiring diagram in which the appa- 'ratus shownin Figs. 33and 34 is utilized.

The machine shown in the accompanying draw'- 'ings embodies a casing 30that has a seat 3|y viewed in Fig. 1'-, With the seat 3i arranged inthisjmanner the left arm of va person seated thereon may beconvenientlyrested on the shelf 32 afforded by the casing 30, this shelf beingdisposed forwardly of an upright housing!! in which` 1.5

. In the present `instance, however, a coin insertedinto the coin slot4i causes engagement of the contacts 41 and 48, Figs. 4 and 26, thisarrangement being one which is common in the art and, since a widevariety of arrangements may be resorted to, it is not illustrated ordescribed in detail herein. After so engaging the contacts 41 and 43,the inserted coin passes to the coin box 43, Figs. 4 and 5, where it isco1- lected along with similarly inserted coins.

4A pair of line wires 50 and 5|, Fig. 2 6, lead from a suitable sourceof electric current, a

v fuse 32 preferably being included in one such line wire, the line wire5i in this instance, for

a purpose well understood in the art. As shown in Fig. 26, the conductor50 leads to a terminal 50a, while a conductor 50h leads to a terminal 13from which a conductor 50' leads to the contact 43. A conductor 53 leadsfrom the contact 41 to a terminal 34 and a conductor `v52' leads fromthe terminal 54 to one end of the windingof the coil of an electromagnetor relay 56. A

conductor 51 leads from the other end of this 'v winding to a terminal58 to which the line wire.

5| is led. It, will therefore be seen that engagementof the contacts 41and 48 closes circuit `through the coil of the electromagnet 5 6whereupon the armature 59 thereof is attracted and this, in a mannerexplained hereinafter, withdraws the retaining pawl 351Figs. 25 and 26,

. from engagement with the ratchet wheeltll whereupon this wheel and theparts associatedv plained hereinafter.

' fingers 6| and 62 being shown in such advanced position in Fig. 26.

By referring to Fig. 2 6 it will be seen that a conductor 65 leads fromthe terminal 58 to the contact fingers 6| and 62. Thus when the contactnger 6| is in engagement with the contact Vstrip 63, as shown in Fig.26, circuit is closed from the ,line wire 5| through conductor65,'contact finger 6|, conductor strip 69 and conductor 66 to terminal61, wherefore circuit is closed to the pump motor 68 in the followingmanner: From terminal 61, through conductor 69, tothe motor 68Vandthence through conductor 10 to tgrmirial 1| and then through conductor'12, terminal 13,

conductor 5017v and terminal 50a to line wire 50.

Thus it will be seenthat when a coin is passedthrough the machine, themotor 68 is set in operation whereby air pumps included rin the machineare vset in operation.

Thus by referringto'Fig. 6 it will be seen that a pinion 14 is providedon the shaft .15 of the motor 68 and thatthis pinion meshes with a gear.

` tainer is effective to force the liquid therefrom through the tube 91leading to the inlet 98 of a 'the pulse, and to this end a bracket 94,Figs. 4, ,9, l10 and 14, is secured to one side wall of the ca'singlnte'iorly thereof and in the present in-l stance the lid 95 of acontainer `96 is carried by this bracket 94, the lid 95 beingscrew-threadedly attached to the container 96 whereby said container issupported from said bracket; lThe tube 9| leads from the pump Pand ispassed through the cover 95 into the container 96 which is pref.

erably, at least, partially filled witha suitable liquid such as water.Air under pressure from the pump AP is therefore supplied to theVcontainer 96 and the pressure thus built up in said con'- valve housing99, Figs. 9, 1 0, 14 and 22. v

By referring toFig. 22 lit will be seen that the valve housing 99includes a main body |00 having a head |0| fast thereto. The inlet .98leads to an inlet port |021in the head I0|. Anoutlet' port |03 is alsoformed inthe head |0| and an outlet 04 leads therefrom. A diaphragm |05is clamped r between the head |0| and the main body `|00 and is medlallyacted upon by the head |06 on a pin |01, said head |06 being disposed ina'chamber |08 formed inthe main body |00 and the pin |01 'being`extended through this chamber and 16 fast on the shaft 11, Figs. 6 and7, that is suitably journaled in the housing of the motor 68. The shaft11 has a disc 18 mounted at thefree end thereof and one end of a crank19 is eccentrically connected to the disc 18 as indicated at 80. Theother end of the crank 19 (see Figs. 6 and-7) is pivotally connected asindicated at 8| to a piston rod 82 which extends into oppositelydisposed pump cylinders 83 and 84 fast to a bracket 65 mounted on ashelf 88, Fig. 4, carried by the casing 30. A conventional piston 61,Fig. 6, is provided at one end of the piston rod 62 and has aconventional leather valve 88 or thelike thereon. It will be understoodthat, in the course of rotation of the disc 16, the crank 19 movesdownwardly from the position in which it is shown in Figs. 6 and '7 andin so doing draws the piston 81 downwardly whereby air is drawn into thecylinder 83 of the p ump P past the valve 68. air entering the cylinder83 past the piston rod -82 and the orifice 69 in the present instance.Then as the crank 19 and piston rod 82 return to the position in whichthey are shown in Fig. 6, air is forced out through the outlet port 90into the tube 9| past the conventional check valve, generally indicatedby 92, which is operative to prevent air flow into the cylinder 83during the movement of thepiston 81 downwardly from the position inwhichit isshown in Fig. 6`in theI course f reciprocation of the piston rod62.. \A piston and valve arrangement similar to that included thecylinder 63 is included in the cylin-V der 64 of thepump P', which pumpserves to force air into the air line 93 for a purpose ex- It will beunderstood that thek pistons in the cylinders 63 and 84 and theirassociated valves work in opposition, which isto say, air is being drawninto the cylinder 64 while r it is being forced from the cylinder 83 andvice versa.. Air under pressure suppliedby the,pump P is utilized, inthe present apparatus, in ascertaining through a stemA |09, that isscrew-'threaded into the end of the body |00 opposite that atwnhich thediaphragm |05 is arranged.- The opposite end of the stem |09 is fastin abracket ||0, secured to the casing 30, and the arrangement is such thatthe valve housing 99 is supported from the, bracket ||0 through the stem|09. A bellows casing is carried by the bracket ||0 on the` sideAthereof opposite that from which the stem |09 projects and a corrugatedsheet metal ex-l tendible expansion vessel or metallic bellows- ||2 isconfined in the bellows housing the open end of such bellows beingdisposed toward the bracket ||0 andv this end of this bellows issuitably secured to said bracket. The end of the pin y|01 opposite thatcarrying the head |06 is;

suitably fast to the closed end of the bellows ||2.

The bellows housing includes an inlet ||3 and an outlet ||4, a'tube ||5interconnecting the outl let |04 and the inlet ||3, a tube ||6 beingconnected to the outlet |I4.

Liquidunder pressure from the container 96 flowing through the tube 91,'inlet 98 and irlet port |02 i's effective onthe diaphragm |05 to unseatit from port-ciosingposition in which it is shown in Fig. 22, and whenthe diaphragmis thus unseated liquid flows'lto the outlet port |03 andthence through the outlet I 04, tube 5 and' inlet ||3 into the'beilowshousing andthen out through the outlet ||4 and tube 6 to the inlet 'H1of the bellows housing |18, Figs. .9, 12 and 14, in which a bellows II9, similar to the bellows ||2, is confined. The bellows housing'HB issecured toand carriedvby avplate |20, Fig. 14,` that issupported fromlthshelf 82 by a bracket 12|, Fig. 4. The bellows housingj H8, the bellows||9,.the plate |20 and parts associated therewith will be 'described infurther detail hereinafter.

The bellows housing 8 includes an outlet |22 Vto whichone end of a tube|23 is connected, and

'this tube is ledthrough an opening |24, Figs..'14

and 16, that extends through the shelf 32 and the armrest 35, andthistube is united-with and Iopens into a bulb |25. w

The strap or wrist band V38, Figs. l, 3, 14 and 16, is so located along.the extent of the arm rest 35 that when the palmof the left hand of auser of the apparatus is disposed in the formed

